Abstract
Introduction:
Parental concern and negative attitudes toward drug use may prevent youth from being involved in drug use. However, few studies have addressed parental concern about children’s drug use and its possible variation by race/ethnicity. In this study, we explored the potential racial/ethnic differences in parental concern about their children’s drug use with a nationally representative sample.
Methods:
The data were from the 2003 National Survey of Children’s Health, a random household telephone survey of parents of children up to age 17 (n = 102 353). The analytic sample was restricted to parents of children aged 6 to 17 years (n = 61 046). Multivariate logistic regression models, controlling for children’s age, gender, family structure, and family poverty level, were fitted, simultaneously accommodating the complex survey design.
Results:
Parents of African American and Hispanic children expressed more concern than parents of white children, even after controlling for potential confounders (adjusted odds ratio (AOR), 1.9; 95% CI, 1.8–2.1 and AOR, 1.9; 95% CI, 1.7–2.1, respectively).
Conclusions:
The level of parental concern about adolescent drug use was different across race/ethnicity groups. The results may have implications for parental participation in school-based adolescent prevention programs.
Keywords: race/ethnicity, children/adolescents, drugs
INTRODUCTION
Late childhood and adolescence are critical periods for the onset and use of substances. According to the Youth Risk Behavior Survey, in 2007, an estimated 20.0% of high school students were current users of tobacco, with marked differences by race/ethnicity: 23.2% for whites, 16.7% for Hispanics and 11.6% for African Americans. In addition, an estimated 44.7% were current users of alcohol and 19.7% were current users of marijuana.1
Social learning and social control theories emphasize that the social environment, both inside and outside the home, influences adolescents’ attitudes regarding drug use.2–4 Hence, many studies have reported that positive parental concern and antismoking attitudes are protective of initiation and further use of tobacco, alcohol, and other drugs.4–12 Low parental concern has been reported to be associated with children’s later involvement in tobacco use,11 as well as a higher odds of progressing from experimental smoking to regular smoking in adolescence.4 Furthermore, Chandy and her colleagues suggested that high parental concern and high maternal education appeared to be the protective factors for male adolescents with use of tobacco products, alcohol, and marijuana.12
The positive association between parental concern and attitudes about drug use and adolescents’ drug use has important implications for school-based drug prevention programs. However, few studies have explored the profile of parental concern about their children’s drug use, and even fewer studies have documented possible racial/ethnic differences. To fill this gap, we used data from a nationally representative survey to explore racial/ethnic differences in parental concern about children’s substance use controlling for their demographic and socioeconomic characteristics.
METHODS
Data Source
The data for this analysis are from the 2003 National Survey of Children’s Health (NSCH), which was designed to provide state- and national-level information on children’s health and well-being, as well as on their families and neighborhoods.13 This telephone survey was conducted by the National Center for Health Statistics. The survey interviewed 102 353 parents or guardians of children who were aged 0 to 17 years old with a response rate of 68.8%. The respondent was one of the parents who was most knowledgeable about the sampled children’s health. Weights were provided to adjust for the complex survey design and for nonresponse rates. Only parents of school-aged children (6–17 years) were asked about their concern about their children taking drugs. Therefore we restricted the analytic sample to parents of 61 046 school-aged children (6–17 years).
Measures
Parental concern was measured by asking, “Please tell me if you are currently concerned a lot, a little, or not at all about (your child’s) substance use?” Parents responded by choosing 1 of 3 response options: “a lot,” “a little,” and “not at all.” Two categories were collapsed to create 2 groups, “concerned a lot or a little” and “concerned not at all.” In addition, parents or guardians identified the race of their children by responding to 2 questions, a yes/no question regarding Hispanic or Latino origin and another question asking parents to describe their child’s race by indicating white, black or African American, American Indian, Alaska Native, Asian, Native Hawaiian, and/or other Pacific Islander. Possible responses were collapsed into the following 5 categories: white, non-Hispanic; Hispanic; African American, non-Hispanic; other race, non-Hispanic; and multiple race, non-Hispanic. “Other race, non-Hispanic” included American Indian, Alaskan Native, Asian, Native Hawaiian, and Pacific Islander; and “multiple race, non-Hispanic” indicated those children for whom more than 1 race, but not Hispanic race, was reported. Age, gender of the child, and family income were reported by the parents. Child’s age was categorized into the following 3 levels to represent elementary school, middle school, and high school–aged youth, respectively: 6 to 10 years old, 11 to 13 years old, and 14 to 17 years old. The NSCH used the 2002 Poverty Guidelines from the US Department of Health and Human Services to create 9 categories describing household poverty status.13 For the purposes of the analyses described below, these were collapsed into 5 groups: 100% poverty level or less, 100%−200% above poverty level, 200–300% above poverty level, 300–400% above poverty level, and at or above 400% poverty level. Family structure was grouped into “2-parent family” and “single-parent or other structure.”
All analyses were performed using STATA 10.0 (Stata-Corp, College Station, Texas),14 which produces accurate variance estimates for complex survey design. Population-based estimates were obtained by accommodating the corresponding sampling weight to each sampled case. Demographic characteristics were analyzed using univariate descriptive statistics, and statistical comparisons were made using bivariate F test at the 0.05 level. Bivariate logistic regression analyses were performed to assess the crude (ie, unadjusted) association of parental concern about their children’s substance use with race/ethnicity and each covariate. Multivariate logistic regression analyses were then performed to evaluate the association while controlling for each covariate in the model.
RESULTS
Among the total sample, approximately 21% of parents had a lot or a little concern about their children’s substance use. Table 1 shows the demographic characteristics of parental concern with regard to each covariate. About 31% of parents of African American children or adolescents and 30% of parents of Hispanic children or adolescents had a lot or a little concern about their children’s drug use, compared to 17% for their white counterparts, 20% for multiple race, and 26% for other racial/ethnic groups. Bivariate analyses indicated associations between parental concern regarding drug use and the age of the child, the gender of the child, family structure, and family income. Parents of older age groups of adolescents had more concern about their children’s drug use.
Table 1.
Selected Characteristics of Parental Concern About Children’s Drug Use
| Not at All | A Lot or a Little | P Value | |
|---|---|---|---|
| n (%wt)a | n (%wt)a | ||
| Race | <.001 | ||
| White, non-Hispanic | 36 203 (82.6) | 7981 (17.4) | |
| Black, non-Hispanic | 3815 (68.6) | 1837 (31.4) | |
| Hispanic | 4925 (70.1) | 1882 (29.9) | |
| Multirace, non-Hispanic | 1727 (80.5) | 438 (19.5) | |
| Others, non-Hispanic | 1620 (73.7) | 618 (26.3) | |
| Gender | <.001 | ||
| Male | 24 536 (77.5) | 6970 (22.5) | |
| Female | 23 754 (79.3) | 5786 (20.7) | |
| Age, y | <.001 | ||
| 6–10 | 19 240 (82.3) | 3699 (17.7) | |
| 11–13 | 12 206 (78.0) | 3193 (22.0) | |
| 14–17 | 16 844 (73.8) | 5864 (26.2) | |
| Family structure | <.001 | ||
| 2-parent family | 35 749 (80.5) | 8562 (19.5) | |
| Single parent or other | 12 541 (73.3) | 4194 (26.7) | |
| Poverty level | <.001 | ||
| ≤100% poverty | 4654 (72.2) | 1777 (27.8) | |
| 100%−200% above poverty | 9086 (75.2) | 2732 (24.8) | |
| 200%−300% above poverty | 9403 (79.4) | 2449 (20.6) | |
| 300%−400% above poverty | 8697 (80.6) | 2159 (19.4) | |
| ≥400% poverty | 16 450 (82.5) | 3639 (17.5) |
Abbreviation: %wt, weighted percent.
The analyses accommodate the complex survey design.
Source: National Survey of Children’s Health, 2003 (n = 61 046).
After fitting logistic regression models, both unadjusted and adjusted odds ratio (OR and AOR, respectively) estimates confirmed the bivariate associations. Results showed parents of African American and Hispanic children had about twice the odds of reporting concern about their children’s drug use as compared to parents of non-Hispanic white children (AOR, 1.9; 95% CI, 1.8–2.1 for African American parents; AOR, 1.9; 95% CI, 1.7–2.1 for Hispanic parents). Parents of children from other races also had higher odds of concern about their children’s substance use (AOR, 1.7; 95% CI, 1.4–2.1).
Other demographic characteristics were also related to parental concern regarding drug use. Parents of 11- to 13-year-olds (AOR, 1.3; 95% CI, 1.2–1.4) and 14- to 17-year-olds (AOR, 1.7; 95% CI, 1.6 1.8) were more likely to report concern about drug use than parents of 6- to 10-year-olds. Parents of girls had a slightly lower odds of “a lot” or “a little” concern about drug use than parents of boys (AOR, 0.9, 95% CI, 0.8–0.9). Parents or guardians who indicated a nontraditional structure (eg, single father) were slightly more likely to report concern about their children’s drug use compared to parents in traditional 2-parent families (AOR, 1.2; 95% CI, 1.1–1.3).
Parents with higher income were less likely to express concern about their children’s drug use (eg, OR, 0.6; 95% CI, 0.5–0.6 for 400% above poverty level). However, once other potential confounders were included in the logistic regression model, the association between parental concern and family income was no longer significant, except for those families whose incomes were more than 400% beyond the poverty level.
DISCUSSION
In this study, parental concern about children’s drug use was found to vary by race/ethnicity, children’s age and gender, poverty level, and family structure using data from a population-based complex survey. Parents of African American and Hispanic children were more likely to express concern about their children’s drug use than parents of white and other racial groups, even after adjusting for the confounding effects of other demographic or socioeconomic status.
At first glance, these findings may be surprising given ethnic group differences in adolescent drug use rates.15 The prevalence of drug use among African American adolescents is lower than the corresponding estimates for white adolescents for marijuana, cocaine, or other illegal drugs, and is especially lower for alcohol or tobacco.16–18 Several possible explanations stem from the literature. It is possible that the lower rates of drug use among African American and Hispanic youth may be a result of higher levels of parental concern among their parents, which was suggested by other studies that parental concern results in the lower prevalence rates of youth drug use.19 In addition, a higher level of parental concern may be due to the African American parents who are poor and tend to live in depressed neighborhoods which tend to be havens of drug use, and thus parents have legitimate concerns about children’s drug use.20 Finally, research must consider the role that parents play in both African American and Hispanic cultures and how this impacts specific parenting practices.19,21,22
Although intriguing, this study was limited by the fact that the National Survey on Children’s Health was a cross-sectional study that only contained information about parental concern about drug use and not actual drug use among children. Thus, it is not possible to determine causality or linkages between parental and child behaviors. In addition, this survey was completed using telephone survey technology, which may exclude individuals without telephone from the sampling frame. However, poststratification was used to correct for potential nonparticipation bias, although there remain concerns that those who did not participate in the survey may not have been adequately represented.23 Self-reported data may introduce recall and social desirability bias. Finally, some other variables that might influence the parental concern on drug use (eg, neighborhood characteristics) were not measured in the survey and thus were not considered in the study.
Notwithstanding these limitations, the present study offers novel evidence on racial/ethnic differences in parental concern about their children’s substance use with a nationally representative sample that is not subject to potential limitations affecting prior studies. The random survey design may have reduced the possibility of selection bias from different geographical locations.
Clearly, more research—particularly those in longitudinal nature—is needed to clarify the ethnic role in association of norms of parents on adolescents’ drug use. If so, the findings of this study might shed light for school-based youth drug use prevention programs for multiethnic populations. Although research has documented that parental participation in the youth drug prevention programs is effective in reducing the risk of youth use of alcohol and cigarettes,24,25 the extent to which these programs include parental participation is actually low, particularly for high-risk subpopulations.26 The identification of levels of parental concern about their children’s drug use may be used to motivate parents to participate in school-based drug prevention programs. More efforts may be needed to better understand the barriers to participation in prevention interventions for parents with lower levels of parental concern about their children’s drug use.
Table 2.
Estimates of the Association Between Parental Concern About Children’s Drug Use and Demographic Variables
| Crude OR | Adjusted OR | |||
|---|---|---|---|---|
| OR (95% CI) | P Value | AOR (95% CI) | P Value | |
| Child race | ||||
| White, non-Hispanic | 1.0 Reference | 1.0 Reference | ||
| Black, non-Hispanic | 2.2 (2.0–2.4) | <.001 | 1.9 (1.8–2.1) | <.001 |
| Hispanic | 2.0 (1.8–2.3) | <.001 | 1.9 (1.7–2.1) | <.001 |
| Multirace, non-Hispanic | 1.2 (1.0–1.4) | .136 | 1.1 (0.9–1.4) | .198 |
| Others, non-Hispanic | 1.7 (1.4–2.1) | <.001 | 1.7 (1.4–2.1) | <.001 |
| Child gender | ||||
| Male | 1.0 Reference | 1.0 Reference | ||
| Female | 0.9 (0.8–1.0) | .002 | 0.9 (0.8–0.9) | .001 |
| Age, y | ||||
| 6–10 | 1.0 Reference | 1.0 Reference | ||
| 11–13 | 1.3 (1.2–1.4) | <.001 | 1.3 (1.2–1.4) | <.001 |
| 14–17 | 1.6 (1.5–1.8) | <.001 | 1.7 (1.6–1.8) | <.001 |
| Family structure | ||||
| 2-parent family | 1.0 Reference | 1.0 Reference | ||
| Single parent or other | 1.5 (1.4–1.6) | <.001 | 1.2 (1.1–1.3) | <.001 |
| Poverty level | ||||
| ≤100% poverty | 1.0 Reference | 1.0 Reference | ||
| 100%−200% above poverty | 0.8 (0.7–1.0) | .030 | 1.0 (0.9–1.2) | .947 |
| 200%−300% above poverty | 0.7 (0.6–0.8) | <.001 | 0.9 (0.8–1.0) | .182 |
| 300%−400% above poverty | 0.6 (0.5–0.7) | <.001 | 0.9 (0.8–1.0) | .088 |
| ≥400% poverty | 0.6 (0.5–0.6) | <.001 | 0.8 (0.7–0.9) | .005 |
Abbreviations: AOR, adjusted odds radio, adjusted by the covariates listed in the table; CI, confidence interval; OR, odds ratio.
Source: National Survey of Children’s Health, 2003 (n = 61 046).
Funding/Support:
This work was supported by the National Institute on Drug Abuse grants DA 12390 and DA019805 and the National Center for Minority Health and Health Disparities grants MD000217 and P60MD000532.
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